Authorization and Referrals Coordinator

Position Summary:

The Authorization Coordinator is responsible for obtaining prior authorizations for prescribed medications and services, ensuring compliance with payor requirements, and maintaining accurate and timely documentation of all related actions.

Pay and Hours:

$17 - $22/hr. 8 hours per day, Monday - Friday

Essential Functions:

To perform effectively in this role, the candidate must fulfill the following duties with or without reasonable accommodations:

• Communicate with payors via phone, fax, or electronic prior authorization (ePA) systems to secure authorizations for medications and procedures.
• Review electronic medical records (EMR) and prior authorization software to identify medications requiring authorization.
• Respond to outstanding prior authorization requests and maintain communication with staff regarding payor medical policies.
• Support patients using high-risk or biologic medications by coordinating renewals and routine screenings.
• Maintain accurate and timely documentation in electronic medical records and ensure actions are recorded appropriately.
• Update and manage prior authorization tracking systems, including data entry and reporting.
• Ensure timely processing of authorizations and communicate status updates to physicians and care teams.
• Advise physicians on payor decisions and recommend additional documentation when necessary to support authorizations.
• Appeal authorization denials under the direction of physicians.
• Proactively manage and process renewals for expiring authorizations.
• Screen and process medication refill requests as appropriate.
• Stay informed about manufacturer assistance programs and maintain communication with drug vendors and sales representatives as needed.
• Consistently demonstrate regular and reliable attendance.
• Perform additional duties as assigned.

Knowledge, Skills, & Abilities:

• High school diploma or equivalent required.
• Minimum of two (2) years in healthcare or prior authorizations.
• Technology Proficiency:
• Familiarity with electronic medical records (EMR) systems and practice management software.
• Proficiency in Microsoft Office applications.

This role requires a proactive, dependable, and detail-oriented individual with the ability to manage multiple tasks in a dynamic healthcare environment. The ideal candidate demonstrates a strong commitment to patient care and operational excellence.

Physical and Mental Demands:

The physical and mental demands described below are representative of those required to perform this job successfully. Reasonable accommodations may be made for individuals with disabilities:

• Physical Requirements:
• Occasionally required to stand, walk, and sit for extended periods.
• Use hands to handle objects, tools, or controls; reach with hands and arms.
• Occasionally required to climb stairs, balance, stoop, kneel, bend, crouch, or crawl.
• Occasionally lift, push, pull, or move up to 20 pounds.
• Vision Requirements:
• Close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

Note:
This job description is intended to provide a general overview of the role. Additional responsibilities may be assigned, or duties modified by the department supervisor based on operational needs.